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Gamage DCT, Jayamanne BDW, Quasim SF, Kailidis K, Olabi A. Neonatal venolymphatic malformation with spontaneous parotid duct rupture: first case report. Oxf Med Case Reports 2022; 2022:omac060. [PMID: 35769188 PMCID: PMC9235025 DOI: 10.1093/omcr/omac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/17/2021] [Accepted: 02/05/2022] [Indexed: 11/17/2022] Open
Abstract
Disorders of salivary glands especially the parotid gland very rare among neonates and children other than cytomegaly and parotitis epidermica. Venolymphatic malformations are very rare in children. Such presentation around the parotid region yet to be reported. This case report describes a rare presentation of a neonatal venolymphatic malformation on the parotid duct. A 4-week-old termly delivered male infant referred to by a general practitioner bruising over the left buccal area for 1 day from non-consanguine healthy parents. On examination a bluish discoloration in the buccal mucosa over a firm mildly tender area without signs of inflammation was seen. Ultrasound examination of the lesion showed fluid and solid soft tissue suggestive of haematoma and magnetic resonance imaging scan confirmed the rupture of the parotid duct with venolymphatic malformation. The child has been referred to the vascular malformation clinic and plastic surgical clinic in a tertiary care hospital for follow-up.
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Affiliation(s)
- Darshanika C T Gamage
- Department of Paediatrics , Furness General Hospital, UHMB Trust, Dalton Ln, Barrow-in-Furness, Cumbria LA14 4LF , UK
| | - Bernard Deepal Wanniarachchi Jayamanne
- Department of Public Health , Faculty of Medicine, University of Kelaniya, Ragama 11010 , Sri Lanka
- Faculty of Health and Medicine , Lancaster University, Bailrigg LA1 4YW , UK
| | - Syed Faizan Quasim
- Department of Paediatrics , Furness General Hospital, UHMB Trust, Dalton Ln, Barrow-in-Furness, Cumbria LA14 4LF , UK
| | - Kosmos Kailidis
- Department of Paediatrics , Furness General Hospital, UHMB Trust, Dalton Ln, Barrow-in-Furness, Cumbria LA14 4LF , UK
| | - Anas Olabi
- Department of Paediatrics , Furness General Hospital, UHMB Trust, Dalton Ln, Barrow-in-Furness, Cumbria LA14 4LF , UK
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2
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Bentivegna K, Grant-Kels JM, Livingston N. Cutaneous Mimics of Child Abuse & Neglect: Part II. J Am Acad Dermatol 2022; 87:519-531. [PMID: 35339589 DOI: 10.1016/j.jaad.2021.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022]
Abstract
Given that some cutaneous mimics of child abuse result from rare disease, they may be more prone to misdiagnosis. For possible child abuse cases in which diagnosis remains uncertain at time of initial dermatologic evaluation, it is important that dermatologists are prepared to distinguish true dermatologic conditions in cases of ambiguous skin findings. Additionally, this review will aid clinicians in recognizing the possibility of concurrent true dermatologic disease and skin findings related to abuse with the acknowledgement that they are not mutually exclusive. Proper recognition of mimics of abuse may prevent unnecessary stress and child protective service investigation.
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Affiliation(s)
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida.
| | - Nina Livingston
- Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
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Makis A, Masina V, Spiteri EA, Aggeli I, Vartholomatos G, Chaliasos N, Pergantou H. A refugee child with multiple patterned ecchymoses: a diagnostic dilemma between nonaccidental injury and primary hemostatic defect. Blood Coagul Fibrinolysis 2021; 32:603-606. [PMID: 33973895 DOI: 10.1097/mbc.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 4-year-old girl from Syria presented to the hospital with multiple bruises on her body. Bruises were observed in protected areas in a shape of fingerprints and objects, while no other bruises occurred during hospitalization. The parents also reported a history of bleeding diathesis from infancy. Both the initial laboratory evaluation and the secondary tests done for possible thrombocytopenia and coagulation factors deficiencies were normal. Thus, the nonaccidental injury protocol of the Hospital was activated, and the possibility of abuse was not quite evident. Investigation for platelet disorders followed. Platelet aggregation test and flow cytometry were indicative of Glanzmann's thrombasthenia. It is of great importance in these cases, that the doctor eliminates any possibility of physical abuse and examines the patient for common and rare primary hemostatic defects, although both can co-exist.
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Affiliation(s)
- Alexandros Makis
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Vasiliki Masina
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Evangelia-Anna Spiteri
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Ioanna Aggeli
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | | | - Nikolaos Chaliasos
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Helen Pergantou
- Haemophilia Centre- Haemostasis and Thrombosis Unit, 'Aghia Sophia' Children's Hospital, Athens, Greece
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Collins PW, Hamilton M, Dunstan FD, Maguire S, Nuttall DE, Liesner R, Thomas AE, Hanley J, Chalmers E, Blanchette V, Kemp AM. Patterns of bruising in preschool children with inherited bleeding disorders: a longitudinal study. Arch Dis Child 2017; 102:1110-1117. [PMID: 27449675 PMCID: PMC5754865 DOI: 10.1136/archdischild-2015-310196] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The extent that inherited bleeding disorders affect; number, size and location of bruises in young children <6 years. DESIGN Prospective, longitudinal, observational study. SETTING Community. PATIENTS 105 children with bleeding disorders, were compared with 328 without a bleeding disorder and classified by mobility: premobile (non-rolling/rolling over/sitting), early mobile (crawling/cruising) and walking and by disease severity: severe bleeding disorder factor VIII/IX/XI <1 IU/dL or type 3 von Willebrand disease. INTERVENTIONS Number, size and location of bruises recorded in each child weekly for up to 12 weeks. OUTCOMES The interventions were compared between children with severe and mild/moderate bleeding disorders and those without bleeding disorders. Multiple collections for individual children were analysed by multilevel modelling. RESULTS Children with bleeding disorders had more and larger bruises, especially when premobile. Compared with premobile children without a bleeding disorder; the modelled ratio of means (95% CI) for number of bruises/collection was 31.82 (8.39 to 65.42) for severe bleeding disorders and 5.15 (1.23 to 11.17) for mild/moderate, and was 1.81 (1.13 to 2.23) for size of bruises. Children with bleeding disorders rarely had bruises on the ears, neck, cheeks, eyes or genitalia. CONCLUSIONS Children with bleeding disorder have more and larger bruises at all developmental stages. The differences were greatest in premobile children. In this age group for children with unexplained bruising, it is essential that coagulation studies are done early to avoid the erroneous diagnosis of physical abuse when the child actually has a serious bleeding disorder, however a blood test compatible with a mild/moderate bleeding disorder cannot be assumed to be the cause of bruising.
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Affiliation(s)
- Peter W Collins
- Department of Haematology, Institute of Infection and Immunity, School of Medicine Cardiff University, Cardiff, UK
| | | | - Frank D Dunstan
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
| | - Sabine Maguire
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
| | - Diane E Nuttall
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
| | - Ri Liesner
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Angela E Thomas
- Department of Haematology, Royal Hospital for Sick Children, Edinburgh, UK
| | - John Hanley
- Department of Haematology, Royal Victoria Infirmary, Newcastle, UK
| | - Elizabeth Chalmers
- Department of Haematology, Royal Hospital for Sick Children, Glasgow, UK
| | - Victor Blanchette
- Department of Paediatrics, University of Toronto, Toronto, Canada,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Alison M Kemp
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
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Paroskie A, Carpenter SL, Lowen DE, Anderst J, DeBaun MR, Sidonio RF. A two-center retrospective review of the hematologic evaluation and laboratory abnormalities in suspected victims of non-accidental injury. CHILD ABUSE & NEGLECT 2014; 38:1794-800. [PMID: 24928052 PMCID: PMC4427034 DOI: 10.1016/j.chiabu.2014.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 06/03/2023]
Abstract
Investigation for bleeding disorders in the context of suspected non-accidental injury (NAI) is inconsistent. We reviewed the hematologic evaluation of children who presented with symptoms of bleeding and/or bruising suspicious for NAI to determine the frequency of hematologic tests, abnormal hematologic laboratory results, and hematologic diagnoses. A retrospective cohort study design was employed at two freestanding academic children's hospitals. ICD-9 codes for NAI were used to identify 427 evaluable patients. Medical records were queried for the details of clinical and laboratory evaluations at the initial presentation concerning for NAI. The median age for the population was 326 days (range 1 day-14 years), 58% were male. Primary bleeding symptoms included intracranial hemorrhage (31.8%) and bruising (68.2%). Hematologic laboratory tests performed included complete blood cell count in 62.3%, prothrombin time (PT) in 55.0%, and activated partial thromboplastin time (aPTT) in 53.6%; fibrinogen in 27.6%; factor activity in 17.1%; von Willebrand disease evaluation in 14.5%; and platelet function analyzer in 11.7%. Prolonged laboratory values were seen in 22.5% of PT and 17.4% of aPTT assays; 66.0% of abnormal PTs and 87.5% of abnormal aPTTs were repeated. In our cohort, 0.7% (3 of 427) of the population was diagnosed with a condition predisposing to bleeding. In children with bleeding symptoms concerning for NAI, hemostatic evaluation is inconsistent. Abnormal tests are not routinely repeated, and investigation for the most common bleeding disorder, von Willebrand disease, is rare. Further research into the extent and appropriate timing of the evaluation is warranted.
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Affiliation(s)
| | | | - Deborah E Lowen
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - James Anderst
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Michael R DeBaun
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Robert F Sidonio
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Lohse J, Stächele J, Heilmann A, Schwier F, Schmidt U, Erfurt C, Knöfler R. Significance of platelet function diagnostics for clarification of suspected battered child syndrome. Hamostaseologie 2014; 34 Suppl 1:S53-6. [DOI: 10.5482/hamo-14-02-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 06/18/2014] [Indexed: 11/05/2022] Open
Abstract
SummarySummary: The manifestation of an unclear bleeding tendency in childhood calls for an extended coagulation work-up, particularly when a battered child syndrome is suspected and typical concomitant injuries are absent. The chosen diagnostic tests should be able to detect the presence of relatively common coagulation defects such as von Willebrand syndrome or hemophilia, but also rare diseases such as inherited thrombocytopathies. The PFA-100® test does not help to provide a definite diagnosis especially in cases of mild inherited thrombocytopathies, since in most cases the PFA-100® test results are normal. For this purpose, specific platelet function testing is needed. However, the methods are only available in some coagulation laboratories. Also, other limitations need to be taken into consideration such as pre-analytical problems and difficulties in the interpretation of test results especially in infants.We present two cases that were diagnosed with an aspirin-like defect as an inherited thrombocytopathy, even though their PFA-100 closure times were within the normal range. Based on pathological findings in the platelet aggregometry test, this diagnosis could be made.
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The medical assessment of bruising in suspected child maltreatment cases: A clinical perspective. Paediatr Child Health 2013. [DOI: 10.1093/pch/18.8.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Michelle GKW, Amy O, Anne N, C Louise M. L’évaluation médicale des ecchymoses dans les cas de maltraitance présumée d’enfants : une perspective clinique. Paediatr Child Health 2013. [DOI: 10.1093/pch/18.8.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Ward MGK, Ornstein A, Niec A, Murray CL. The medical assessment of bruising in suspected child maltreatment cases: A clinical perspective. Paediatr Child Health 2013; 18:433-42. [PMID: 24426797 PMCID: PMC3887084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Bruises commonly occur in children and are most often the result of a minor accidental injury. However, bruises can also signal an underlying medical illness or an inflicted injury (maltreatment). Although bruising is the most common manifestation of child physical maltreatment, knowing when to be concerned about maltreatment and how to assess bruises in this context can be challenging for clinicians. Based on current literature and published recommendations, this practice point will help clinicians to distinguish between accidental and inflicted bruises, to evaluate and manage bruising in the context of suspected child maltreatment, and to evaluate for an underlying medical predisposition to bruising.
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Jackson J, Carpenter S, Anderst J. Challenges in the evaluation for possible abuse: presentations of congenital bleeding disorders in childhood. CHILD ABUSE & NEGLECT 2012; 36:127-134. [PMID: 22398301 DOI: 10.1016/j.chiabu.2011.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/26/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To describe children with congenital bleeding disorders that present in a manner that may be concerning for non-accidental trauma (NAT), and to evaluate associations with disease and demographic characteristics. METHODS Ten year retrospective chart review of subjects at a Hemophilia Treatment Center. Demographic, historical, and disease characteristics were collected. Findings were compared to a priori criteria for bleeding/bruising that is concerning for abuse. RESULTS Twenty-nine (15.3%) of the 189 children in the study had an initial presentation that was concerning for NAT. Of those 29, 75.9% were <5 years of age, 44.8% had von Willebrand disease (vWD), 51.8% had hemophilia, and 48.3% had a family history of a named bleeding disorder. Children from 9 months through 5 years of age were more likely than older children to present with findings concerning for abuse (OR 3.32, 1.21-9.10). No association was detected between presentation concerning for abuse and gender (OR 1.51, 0.6-3.77). Hemophilia was no more likely than vWD to present in a manner that was concerning for abuse (OR 0.7, 0.31-1.58). No children presented with patterned bruising. CONCLUSIONS Children with bleeding disorders may present with bruising/bleeding that is clinically highly suggestive of NAT. PRACTICE IMPLICATIONS Infants and young mobile children who have non-patterned bruising or bleeding as the only symptom concerning for abuse require an evaluation that includes testing for hemophilia and vWD. Children who have laboratory testing that indicates the presence of a bleeding disorder, but have clinical findings concerning for abuse, may benefit from a collaborative evaluation including a pediatric hematologist and a child abuse pediatrician.
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Affiliation(s)
- Jami Jackson
- Children's Mercy Hospital, Department of Emergency Medicine, Kansas City, MO, USA
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11
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Abstract
Abusive head trauma is a leading cause of morbidity and mortality in infants and young children. These patients will often first present to the emergency department. They may present with dramatic or subtle findings. It is important that pediatric emergency physicians be aware of the possible presentations of abusive head trauma. This article will review the epidemiology, the clinical findings, the diagnosis, the differential diagnosis, and the management of abusive head trauma.
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Affiliation(s)
- Bruce E Herman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine and Primary Children's Medical Center, Salt Lake City, UT, USA.
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12
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Singleton T, Kruse-Jarres R, Leissinger C. Emergency Department Care for Patients with Hemophilia and Von Willebrand Disease. J Emerg Med 2010; 39:158-65. [DOI: 10.1016/j.jemermed.2007.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 12/14/2007] [Accepted: 12/23/2007] [Indexed: 11/15/2022]
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13
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Harris TS. Bruises in children: normal or child abuse? J Pediatr Health Care 2010; 24:216-21. [PMID: 20620847 DOI: 10.1016/j.pedhc.2009.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 03/17/2009] [Accepted: 03/30/2009] [Indexed: 11/27/2022]
Abstract
Bruises in active children are common and often are considered "normal" childhood injuries. However, bruises also may be the result of physical abuse or other conditions. The evaluation of a child with bruising should include a thorough history and physical examination to determine the cause. When abuse is suspected, prompt reporting is necessary to protect the child from further injury. This article provides information intended to assist nurse practitioners and other pediatric health care providers in their decision making when assessing a child with bruises.
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Affiliation(s)
- Tomika S Harris
- University of Texas Health Science Center at Houston School of Nursing, 6901 Bertner Ave #769, Houston, TX 77584, USA.
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14
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Coagulation Disorder as a Presentation of Cystic Fibrosis. J Emerg Med 2010; 38:320-2. [DOI: 10.1016/j.jemermed.2007.10.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 05/17/2007] [Accepted: 10/28/2007] [Indexed: 11/30/2022]
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Gordon M, Prakash N, Padmakumar B. Factor XIII deficiency: a differential diagnosis to be considered in suspected nonaccidental injury presenting with intracranial hemorrhage. Clin Pediatr (Phila) 2008; 47:385-7. [PMID: 18057145 DOI: 10.1177/0009922807309065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Morris Gordon
- Department of Paediatrics, Royal Oldham Hospital, Rochdale Road, Oldham, United Kingdom.
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Abstract
You can't teach old dogs new tricks. Teaching middle-aged dogs new tricks is hard enough. They tend to stick to particular styles of attacking the postman that over the years have proved pretty reliable, often choosing to ignore new findings, or simply failing to keep up with progress in current discussions on, say, the old trouser versus postbag debate. Some unsettling papers are even asking whether dogs really need to attack postmen at all.
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Affiliation(s)
- Duncan Cameron
- Department of Paediatrics, Glan Clwyd Hospital, Rhyl, Denbighshire LL17 0DF, UK.
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Abstract
The present understanding of the coagulation process emphasizes the final common pathway and the proteolytic systems that result in the degradation of formed clots and the prevention of unwanted clot formations, as well as a variety of defense systems that include tissue repair, autoimmune processes, arteriosclerosis, tumor growth, the spread of metastases, and defense systems against micro-organisms. This article discusses diagnosis and management of some of the most common bleeding disorders. The goals are to provide a simple guide on how best to manage patients afflicted with congenital or acquired clotting abnormalities during the perioperative period, present a brief overview of the methods of testing and monitoring the coagulation defects, and discuss the appropriate pharmacologic or blood component therapies for each disease.
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Affiliation(s)
- Doreen E Soliman
- Division of Pediatric Anesthesiology, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
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18
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Abstract
Bruising and bleeding are commonly seen in children and are usually associated with minor injury and trauma. However, in two groups of children the bruising may be more significant than expected: those with an underlying haemostatic abnormality, such as an inherited bleeding disorder, or those who have been subjected to non-accidental injury (NAI). Diagnosing inherited bleeding disorders in children is fraught with difficulty, from venous access to interpretation of results; the possibility of NAI should be borne in mind, even in those children with proven significant bleeding disorders when the severity of the injury and the history are non-compatible. We describe the investigation of the haemostatic system in children with bruising and/or bleeding with emphasis on the key haemostatic disorders that need to be excluded.
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Affiliation(s)
- Kate Khair
- Haemophilia Comprehensive Care Centre, Great Ormond St NHS Trust, London, UK.
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Johnson LH, Gittelman M. Management of Bleeding Diathesis: A Case-Based Approach. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2005. [DOI: 10.1016/j.cpem.2005.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
PURPOSE OF REVIEW The many forms of child maltreatment exact an unacceptably heavy toll on our children. Recent work exploring the risk factors for child abuse and neglect, long-term consequences of child maltreatment, and potential for primary prevention will be reviewed. In the past year there have been many notable contributions in the field of shaken baby syndrome that have deepened our understanding of this devastating form of child abuse. RECENT FINDINGS Evidence of the long-term sequelae of child abuse and neglect continues to accumulate, but with increased understanding of the clinical manifestations of child maltreatment has come greater ability to intervene early and perhaps improve long-term outcomes. Although the effectiveness of some home visiting programs to prevent child maltreatment is coming into question, rigorous review of program components is helping to improve quality. There remain controversies in the diagnosis of shaken baby syndrome but several carefully done case-series are clarifying our knowledge of the myriad presentations of this form of non-accidental head trauma. SUMMARY Pediatricians have an important role to play in the prevention and recognition of child maltreatment.
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Affiliation(s)
- Alice W Newton
- Department of Pediatrics, Harvard Medical School, and the Child Protection Program, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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